What is NEMT mileage reimbursement?
NEMT mileage reimbursement pays a Medicaid rider, or a family member, friend, or neighbor who drives them, a set amount per mile for trips to covered care. It is often the least costly mode a broker can approve. Texas runs it as the Individual Transportation Participant program, and Missouri's MTM Link app calls it gas mileage reimbursement. The trip usually has to be approved before it happens.
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How mileage reimbursement fits into NEMT
Federal rules require states to use free rides first and then the least costly mode that fits the rider. For someone with access to a car, paying for gas often beats sending a van. Georgia’s broker, for example, may use gas reimbursement for urgent care or as a backup.
There is one federal catch. When a state covers NEMT as a medical service, it can pay only providers, never the rider. Direct payments to riders have to be claimed as an administrative activity. Texas, for example, registers each driver before paying anyone.
How Texas runs it
Texas’s fee-for-service program calls these drivers Individual Transportation Participants (ITPs). An ITP uses a personal vehicle to drive themselves, a friend, or a family member to the doctor, dentist, or drug store. The steps:
- The client calls the Medical Transportation Program and asks to ride with a would-be ITP.
- TMHP mails that person a registration package, including a direct deposit form.
- After approval, TMHP sends an identifier and a taxonomy code for claims.
- For each authorized ride, MTP mails the client a preprinted service record, Form H3017.
- The doctor, dentist, or drug store signs the form as proof the authorized ride was taken. The ITP signs it too and mails it to TMHP within 95 days of the ride.
ITPs register with TMHP but do not enroll as Medicaid providers. TMHP recommends HCPCS code S0215 and taxonomy code 347C00000X, Private Vehicle, for their claims.
Rules by program
| Program | Who can drive | Rate | Key rule |
|---|---|---|---|
| Texas MTP (fee-for-service) | Client, responsible party, family member, friend, or neighbor | Set by the program | Every ride authorized in advance, form signed by the medical provider |
| Modivcare, Texas | Member, family, or friend | 72.5 cents per mile from January 1, 2026 | Gas ITP claim form, with digital trip logs available |
| Missouri (MTM) | Participant or anyone who drives them | Set by the program | Submit in the MTM Link app on the day of the ride, or use a paper trip log |
| California Medi-Cal plans | Family or friend, not the member | IRS medical mileage rate | Member attests that other transportation resources have been reasonably exhausted |
Missouri also caps distance by county type. A primary care visit qualifies within 10 miles in an urban county, 20 in a basic county, and 30 in a rural county. Exceptions cover referrals for a special condition, an existing specialist relationship, and cases with no appointment available within 30 days.
An example
A rider in rural Missouri has a cardiology visit 40 miles away, inside the 100-mile limit for cardiology in a rural county. Her health plan allows gas mileage reimbursement, so her son drives her. He taps “I’m Leaving” in the MTM Link app at home and “I’m Here” at the clinic, and the app checks the location against the doctor’s address. He submits the claim that same day, because after that the app will not accept it and he would need a paper trip log.
Mileage reimbursement vs nearby terms
- Loaded miles: what a NEMT provider bills per mile with the rider on board. Mileage reimbursement pays a private driver instead.
- Volunteer driver: a friend or neighbor who drives the rider. Texas treats a neighbor as an eligible ITP.
- IRS mileage rates: tax figures, not Medicaid rules. Some programs tie their rate to them. The IRS raised its 2026 business rate from 72.5 to 76 cents on July 1.
For fleets, every mileage trip is one that never reaches the dispatch board. Riders who need a lift, securement, or a stretcher still need a NEMT vehicle.
Frequently asked questions
- Can a rider be reimbursed for driving themselves?
- It depends on the program. Texas lets the client register as the driver, and Missouri reimburses participants who drive themselves. In California, a Medi-Cal plan's summary of DHCS All Plan Letter 22-008 says the member cannot be the driver, so a friend or family member has to drive.
- What rate do mileage programs pay in 2026?
- Each program sets its own. Modivcare moved its Texas rate from 70 cents to 72.5 cents per mile on January 1, 2026, as directed by the IRS. The IRS business rate was 72.5 cents from January 1 to June 30, 2026 and 76 cents from July 1. Under APL 22-008, California plans reimburse gas mileage consistent with the IRS medical rate, which went from 20.5 to 23.5 cents on July 1, 2026. Confirm the current rate on your program's claim form.
- Do I need approval before the trip?
- In Texas and California, yes. Texas pays only trips that its Medical Transportation Program authorized in advance. California plans must authorize private vehicle use before it happens. Missouri checks each claim differently: the MTM Link app confirms that your location matches the doctor's address.
